Healthcare Provider Details

I. General information

NPI: 1104832427
Provider Name (Legal Business Name): WILLIAM DAVID AGOR PSYD, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24402 W LOCKPORT RD UNITR 2B
PLAINFIELD IL
60544-4206
US

IV. Provider business mailing address

1708 SIERRA HIGHLANDS CT
PLAINFIELD IL
60586-5934
US

V. Phone/Fax

Practice location:
  • Phone: 630-621-5824
  • Fax: 815-230-3652
Mailing address:
  • Phone: 815-254-7655
  • Fax: 815-230-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00022322754
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS PROVIDER NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: